Who Misuses Prescription Drugs?

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WASHINGTON – The demographic characteristics of students who are likely to misuse prescription drugs are well-documented: these students are most often white, male, and involved in the Greek system, and they have lower grades than their peers.

Less well-known are the psychological traits that might lead students to abuse psychotherapeutics such as stimulants and sedatives, which the National Survey on Drug Use and Health has found to be the fourth most popular drug of choice among the college crowd. (Their popularity is growing fast: multiple studies have found prescription drug misuse increased fivefold from 1999 to 2005.)

Genevieve Verdi, a doctoral candidate in school psychology at the University of Rhode Island, has tried to get the ball rolling with a study she and a group of colleagues conducted on the psychological variables associated with nonmedical prescription stimulant use, which she presented here this month at the annual conference of the American Psychological Association.

She found that “psychological distress” symptoms such as hostility and obsessive compulsion, as well as sensation-seeking behavior, are more evident in students who misuse prescription drugs. But breaking her data down further to single out students with attention deficit hyperactive disorder, she found that, while these students are among those abusing the drugs -- even to a greater extent -- they also exhibit significantly fewer psychological distress symptoms.

Just under 21 percent of the students 390 surveyed at a Northeastern state universityreported having misused such drugs – 7.5 percent within the last 30 days. National surveys of college students typically don’t ask about lifetime use, so it’s difficult to compare the 20.8-percent finding to anything. However, the most recent National Survey on Drug Use and Health, in 2009, reached similar though slightly less dramatic conclusions regarding past-month use: 6.3 percent of its 18- to 25-year-old participants had used prescription-type drugs nonmedically in the past month – and that’s up from 5.5 percent in 2002.

“The bottom line is, our participants are saying stimulants are pretty easy to get, and they don’t particularly think they’re too risky,” Verdi said. “Like with any medication, the more it’s prescribed ... the more likely it is to fall into the wrong hands – that is, someone it’s not prescribed to, to be used recreationally or just not under the care of a physician.”

About 5 percent of survey respondents reported having been diagnosed with ADHD. A third of those students reported taking medication for ADHD, but even when accounting for pills taken for medical purposes, generally this group had “significantly higher ratings” of stimulant misuse than the non-ADHD group. This made sense, Verdi said, because students with the disorder also reported higher rates of the psychological “distress” symptoms that she found correlate with more prescription drug abuse.

Generally, students who abused stimulants also demonstrated higher “sensation-seeking behavior,” measured by how likely someone is to seek out novel stimuli. Verdi also found correlations between stimulant use and all nine forms of psychological distress -- depression, anxiety, hostility, somatization, sensitivity, phobia, paranoia, psychoticism and obsessive compulsion. The final correlation was with internal restlessness, which in adults causes a constant restless drive to do something, to be up and moving. (Not surprisingly, internal restlessness can also be related to sensation-seeking behavior, which the report notes is correlated with lower GPAs.)

But the results for ADHD students were different: while they also demonstrated the correlation between stimulant use and sensation-seeking behavior, the psychological distress is less of a factor. Students with ADHD who used stimulants also indicated only two forms of psychological distress: hostility and obsessive compulsion. And stimulant use for students with ADHD is not correlated with internal restlessness, as it is for students without ADHD.

One possible explanation for the difference is that these students use stimulants for different reasons than students without ADHD do, the report says. “For example, using stimulants to get high at a party may be associated with different psychological variables than a student taking stimulants to focus in class” – though it’s worth noting here that most students, with and without ADHD, do report using prescription medications because they believe it helps them perform better academically.

Students with ADHD also tend to believe, more so than students without the disorder, that it’s safe to use stimulants on campus (despite the fact that half reported hiding their medications to prevent theft).

Considering the lack of studies not just on students with ADHD and their prescription drug use, but on students with ADHD generally, it’s not surprising that Verdi concluded her presentation with a call for more research.

But both Verdi and Arthur D. Anastopoulos, a psychology professor and director of the ADHD clinic at the University of North Carolina at Greensboro, said these findings illustrate the need for colleges to educate students on the dangers of illicit prescription drug use, especially students with ADHD.

Given college students’ hectic lifestyles, it’s difficult to schedule them for regular treatment, Anastopoulos said. And the confluence of two tendencies – of students with ADHD not knowing what services are available to them, and of students taking prescription drug abuse more lightly than other behaviors – exacerbates the need for colleges to reach out to these students and make sure they know what resources they do have.

Colleges should evaluate the on-campus services they offer students with ADHD, and also make sure the students who are getting prescriptions truly need them, Anastopoulos said. “We need to change the way we think about looking at college students with ADHD. It’s a very different development period; it’s a very different culture,” he said of the college years -- which he described as a sort of black hole when it comes to research of people with ADHD, as most of this research is conducted during subjects’ childhood or adulthood. “We’ve just got to start thinking outside the box a little bit and think of new models for delivering services to this population.”